Tomlinson Professor of Political Theory, McGill University, blogging about political theory, political science, academic life, books, geekstuff, and coffee.

Monday, March 22, 2010

A health-care reform thought

The rightward shift in crime policy and welfare policy of the mid-1990s-- basically, welfare reform plus all the Giuliani-era policing improvements-- ultimately benefited Democrats. They stopped the fearful exodus of whites from the party by undermining the two great pathologizing narratives about blacks.

I wonder whether something similar could happen with health care reform. One important source of working-class and middle-class resistance to creative destruction and freer markers over the past couple of decades has been the terror of losing health insurance along with a job, especially but not only for those whose families include someone with a preexisting condition. If a period of unemployment or self-employment lasted longer than COBRA benefits, it became very frightening regardless of savings in the bank or the profitability of the new self-employment; and any job turnover at all was very problematic for those with pre-existing conditions.

I wonder whether health care reform will take some of that fear away, and so make the prospect of turnover seem less like a potentially-mortal threat. No one's going to welcome losing their jobs! But the intensity of opposition to, say, free trade agreements might diminish.

Notice this is not a story about Republicans benefiting because of a backlash against the bill; rather, it assumes that the bill, like all entitlements, will be untouchable and will therefore fade into the background.

Update: Another, ;largely-unrelated, thought, about the relationship between the new law and the insurance industry's self-interest.

This turns the US health insurance industry into something a lot like the water, gas, phone, and electricity utilities in the US between the Progressive era and 1980. They're private and more or less guaranteed a rate of return to capital, but the terms on which they provide service is much more tightly regulated, and will approximate being universal. This is a somewhat unappealing model for lots of reasons; it manages to be pro-business and pro-capital while also being anti-innovation and anti-entrepreneurship. The moves of the late 70s and early 80s away from this model were largely desirable. But the utility model has its (so to speak) utility; it provides private capital for the industry, provides widespread coverage for consumers, and provides at least a little competition and innovation. Indeed the health insurance version will have somewhat more competition than the post-Progressive Era version, since it will lack the enforced protection of allegedly-"natural" monopolies. Insurance industries will still be in competition with each other, albeit in a more constrained way.

1 comment:

Anonymous
said...

Nice point with the utilities comparison. But the advantage that you cite--the ability to access private capital--is not applicable to health insurance, a much less capital-intensive service. I see no real justification for private health insurance at all--it looks like the worst sort of PPP, with public money going to a completely useless and wasteful middle-man.

The unappealing aspects that you cite also strike me as being appealing with regard to health insurance--innovation is generally a bad thing in health insurance. (It is like innovation in finance. In the 2008 debacle, we Burkeans were finally shown to be sensible.)And competition among insurers is not really a good either--in the big picture, it doesn't lead to efficiency, but simply leads to more administrative waste (think of how much Canadians save by not having to advertise their health insurance programme).